CLINTON CITES FLORIDA
AS CASE EXAMPLE OF NEED FOR MEDICARE
Releases New Report on Need For Drug Benefit for Medicare
Beneficiaries With Disabilities
TODAY, IN AN EVENT AT THE DAVID BARKSDALE SENIOR CENTER IN TAMPA,
FLORIDA, PRESIDENT CLINTON WILL CRITIQUE THE SHORTCOMINGS OF THE HOUSE
REPUBLICAN PRESCRIPTION DRUG PROPOSAL AND RELEASE A NEW DOMESTIC POLICY COUNCIL
/ NATIONAL ECONOMIC COUNCIL REPORT HIGHLIGHTING THE NECESSITY OF PRESCRIPTION
DRUG COVERAGE FOR MEDICARE BENEFICIARIES WITH DISABILITIES. The President will
cite Florida as a case example of why a private insurance model, such as the
one proposed by the House Republicans, will not work. He will point out that
most Medicare beneficiaries in Florida who need affordable prescription drug
coverage must turn to the expensive and limited-value private Medigap options
or the unreliable Medicare managed care market. The new White House report
documents how Medicare beneficiaries with disabilities are in poorer health and
require more prescriptions. The President will highlight the finding that
Medicare beneficiaries with disabilities who lack prescription drug coverage
pay fully 50 percent more out of pocket for 50 percent fewer prescription drugs
than those with coverage. This report strongly validates the need for a
voluntary Medicare prescription drug benefit that rejects the private insurance
model and instead offers an affordable and meaningful Medicare benefit for all
eligible people with disabilities as well as all seniors.
PRESIDENT CITES FLORIDA AS CASE EXAMPLE OF NEED FOR MEDICARE
PRESCRIPTION DRUG BENEFIT. The President will point to the barriers 2.7
million Floridian Medicare beneficiaries face in accessing affordable
prescription drugs. He will cite the private Medigap insurance market in
Florida and throughout the nation, which provides for an expensive but
extremely limited benefit with no protections against catastrophic expenses.
The President will also highlight the serious shortcomings of Medicare managed
care plans, which all too frequently move in and out of participation in the
program and recently announced decisions that would effectively drop 87,000
Floridians. He will underscore that while the Medicare managed care program
needs to be strengthened through the provision of direct subsidies for
prescription drug coverage, neither it - nor a Medigap drug-only plan - can be
relied on as workable options to provide a much-needed prescription drug
benefit for seniors and people with disabilities.
PRESIDENT CLINTON RELEASES A NEW STUDY ON THE IMPORTANCE OF MEDICARE
TO PEOPLE WITH DISABILITIES. About one in eight Medicare beneficiaries -
over 5 million (284,000 in Florida) are people with disabilities under
age 65. Over the next 10 years, the number of beneficiaries with disabilities
is projected to increase by 38 percent (from 5.5 to 7.6 million). Key findings
of the report include:
- Medicare Beneficiaries with Disabilities Have Poor Health and
Significant Health Care Needs. Most disabled beneficiaries -- 60 percent of
disabled beneficiaries report fair to poor health, compared to 22
percent of aged beneficiaries. Nearly 30 percent have functional limitations
due to health problems, compared to 18 percent of elderly beneficiaries.
- People with Disabilities Face Unique Coverage Challenges.
Medicare beneficiaries with disabilities are much less likely to have, be
able to access, or be able to afford private insurance coverage. The report
- People with disabilities are 35 percent less likely to have
employer-based coverage. While some elderly get coverage through retiree
health plans, the non-elderly disabled have typically lost access to
employer-based insurance before qualifying for Medicare (22 percent for
disabled versus 34 percent for aged).
- Restricted access to individual Medigap insurance with drugs.
Less than one in 20 Medicare beneficiaries with disabilities have drug
coverage through private Medigap insurance (versus 12 percent of elderly
beneficiaries). A recent study found that only 10 states guarantee people with
disabilities access to a Medigap plan with prescription drugs.
- Unaffordable premiums for private Medigap plans. Only 7 of the
10 states that guarantee access to Medigap for people with disabilities have
full or partial community rating that improves the affordability of this
coverage. Without protections, premiums range from 10 to 72 percent higher for
beneficiaries with disabilities than for those who are elderly.
- People with disabilities unlikely to get prescription drug
insurance through Medicare managed care. While about 12 percent of Medicare
beneficiaries are disabled, only 5 percent of Medicare managed care enrollees
are beneficiaries with disabilities. In contrast, in 1996, 16 percent of
elderly beneficiaries got drug coverage through managed care.
- Beneficiaries with disabilities need a voluntary Medicare
prescription drug benefit. The report concludes that to ensure access for
people with disabilities, a prescription drug benefit must:
- Ensure a Medicare option rather than rely on private insurers that
have failed to extend prescription drug coverage to people with disabilities.
Only a small number of beneficiaries with disabilities have access to drug
coverage through private insurers, and when they do, it is often unaffordable.
As such, any proposal must provide a Medicare prescription drug option.
- Have an affordable premium and a meaningful benefit. Any
proposal must have sufficient financing to ensure that premiums are affordable
to all Medicare beneficiaries. And to ensure that its benefit is meaningful, it
must protect against catastrophic prescription drug expenses. Medicare
beneficiaries with disabilities are more likely to have high drug costs given
their greater use.
- Have access to the prescriptions that they need and pharmacies
that they trust. Because Medicare beneficiaries with disabilities often
have multiple, complex health problems, it is also important that proposals
allow doctors to prescribe any drug that is medically necessary. Also, people
with disabilities often face physical challenges in getting to pharmacies.
Proposals should ensure that qualified community pharmacies can
- Be adequately financed and part of a plan to improve Medicare.
Strengthening Medicare is the best way to assure that it will be available when
future retirees and people with disabilities need it. Extending program
solvency, improving efficiency, and restoring provider payments should be
included in any Medicare reform plan. Additionally, enough budget surplus must
be set aside to finance a meaningful prescription drug benefit and take its
trust fund off budget.
THE HOUSE REPUBLICAN PRIVATE INSURANCE PLAN IS FLAWED. Their
- Does not provide a Medicare benefit. Outpatient prescription
drugs would not be part of the Medicare benefits package like doctor or
hospital care. Beneficiaries would pay expensive premiums to private Medigap
plans rather than to Medicare for an affordable option. The private insurance
industry itself confirms that a private insurance model such as the House
Republican proposal will not work. In fact, it has stated that "to pass
legislation to provide access to such coverage would constitute an empty
promise to Medicare beneficiaries." [Blue Cross / Blue Shield Association
Letter to Senator Roth, 4/24/00]
- Is seriously underfunded and provides for an inadequate benefit.
The House Republican plan dedicates less than half of the resources the
President and the Democratic leadership allocates to a Medicare prescription
drug benefit ($40 billion versus over $80 billion). As a result, the premiums
are approximately 30 percent higher ($25 versus $37), and its benefits are
significantly less meaningful ($0 deductible versus $250 deductible;
catastrophic stop-loss protection beginning at $4,000 versus $6,000).
- Would leave millions of Medicare beneficiaries without prescription
drug coverage. The Congress' own budget office has projected that the
House Republican plan would leave out over half of the Medicare beneficiaries
who currently have no prescription drug coverage. This finding validates that
the House plan is underfunded and does not provide sufficient benefits to be
able to make the prescription drug option attractive or affordable enough to
some of the nation's most vulnerable seniors and people with disabilities.
- Limits choice of drugs and pharmacies. The so-called "choice"
model offered by the Republicans breaks up the pooled purchasing power of
seniors and people with disabilities, forcing insurers to reduce prices through
restrictive formularies and limited choice of pharmacies. Not all prescription
drugs that a doctor determines are medically necessary would be available
only after an inappropriate drug has been taken can a beneficiary appeal
for a needed drug. Additionally, insurers could restrict access to local
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